New 'house call' for teens

The teenager’s cellphone buzzes. Her doctor, Natasha Burgert, is texting her: “Better morning with this medication?” Another teenager opens his phone.

[CREDIT: Shutterstock]

“Everything is great,” reads Burgert’s discreet text. “Go ahead with the plan we discussed. Please reply so I know you received.”

And on the morning of college entrance exams, a teenager who suffers from a roiling stomach reads Burgert’s texted greeting: “Prepared. Focused. Calm. Your body is healthy and well. Good luck today.”

Burgert, a pediatrician in Kansas City, Mo., is making house calls. She is among a small but growing number of practitioners using social media to engage adolescents. Her patients read her blog and follow her on Twitter and Facebook. She even follows a few of the teenagers’ blogs, commenting occasionally.

During checkups, Burgert no longer gives teenagers brochures with advice on healthy living — which usually led to glazed expressions and teeming wastebaskets. Instead, a whiteboard hangs in her exam room, with hyperlinks and QR codes to sites with teenager-friendly material on sexuality, alcohol and drugs. The teenagers can photograph the board with their phones, storing the information to peruse in private.

Those topics dispensed with, Burgert has more time to listen to her patients.

“This is a time for you,” she will say. “What do you want to talk about?” She often picks up subtle problems like stomachaches due to test anxiety.

She sustains those relationships through social media and, rather than leave teenagers unguided about dicey health matters, she continues sending them links to appropriate websites.

“I do as much as I can to get it on their phones, because that is what they live and die for,” Burgert said.

[CREDIT: Shutterstock]

She gets parents’ permission, because she doesn’t want them checking a child’s phone and chancing upon sites about, say, sexually transmitted diseases.

Medical practices are increasingly putting up Facebook pages to promote business and solder their community of patients. By adding social media, pediatricians and clinics are now capturing teenagers, some of their most elusive patients.

Unlike younger children, who may see pediatricians several times a year, teenagers visit doctors infrequently. Generally healthy, they may stop by only for health forms for work permits, driver’s licenses and sports teams.

But even as they insist on their growing independence, conflating privacy with secrecy, teenagers can be vulnerable to high-stakes, impulsive behavior. Monitoring them carefully but respectfully is tricky for doctors as well as parents. So while a decade ago practitioners saw the Internet as the enemy, a tool for demanding patients who brandished printouts during visits and called at all hours with obscure questions, adolescent-medicine specialists and pediatricians are now turning technology to their advantage.

The payoff, say doctors who text, tweet and post, is a better-informed teenager who finds social media a faster and less embarrassing means to have questions asked and answered.

“I feel more attached to Dr. Natasha this way,” said Marie, 16, a high school junior from Kansas City, Kan. “It’s kind of cool. It’s direct. I don’t have to go through the office ladies. And I like having another adult who is safe to go to.”

But using social media also raises questions about doctor-patient boundaries, privacy laws and confidentiality. What rules should doctors establish about texting with teenagers: content, hours and expectations of speedy replies? How should doctors take into account the reality that teenagers’ cellphones are often missing in action, only to be found — and pored over — by friends and parents?

Because texting is not encrypted and does not comply with privacy laws, “my clinic rules forbid me,” said Dr. Wendy Sue Swanson, a pediatrician who treats teenagers at the Everett Clinic, outside Seattle.

During visits, she will ask a teenager the safest way to pass along private information. For those on birth control, she’ll say, “Take out your cellphone and put in a daily alarm about when to take your pill. Call it . . . ‘strawberry."’

In New York, Mount Sinai Hospital’s Adolescent Health Center uses a program called Text in the City to send patients tips and reminders about medications and appointments. Patients can also text questions, understanding that answers may not arrive for 24 hours.

Dr. Katie Malbon, who writes most of the responses, said she cautions: Delete an answer after reading it.

Many doctors cannot imagine adding social media responsibilities to an already exhausting practice. Burgert, 36, is a juggernaut: She carries a paper notebook to jot reminders and spends 15 minutes a day sending texts and emails. It saves her hours of phone tag with patients.

The teenagers don’t overload her with exchanges, she said.

“They understand it is a privilege, that not all physicians will do this. Actually, I have more problems with first-time parents.”

Last modified: October 23, 2012
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